Manager - Case Management RN
Trinity Health•Springfield, MA
•Onsite
About The Position
At Mercy Medical Center the Case Management Department helps patients coordinate and navigate through their Health care needs while determining how to provide that care efficiently to control costs. The Nurse Manager – Case management provides strategic and operational leadership for inpatient care coordination, case management, and utilization management services. This role partners with physicians, hospital leadership, and system stakeholders to ensure high‑quality, cost‑effective, patient‑centered care while optimizing throughput, length of stay, and regulatory compliance.
Requirements
- Active Registered Nurse (RN) license in Massachusetts
- BSN required
- Minimum 5 years of healthcare experience, including leadership or management
- Experience in care coordination, case management, utilization management, or patient flow
- Strong communication, analytical, and change‑leadership skills
Nice To Haves
- MSN or Master’s in related field preferred
- Master’s degree (MSN or related healthcare field)
- Experience in utilization management, denial management, and payer relations
- Prior leadership experience in a large health system or multi‑department environment
- Knowledge of CMS regulations, payer requirements, and care management best practices
Responsibilities
- Lead Care Coordination and Case Management teams, including staff development, performance management, and engagement
- Promote evidence‑based nursing practice, patient safety, and interdisciplinary collaboration
- Oversee utilization management processes, level‑of‑care determinations, concurrent reviews, denials management, and appeals
- Collaborate with Physician Advisors, Finance, Revenue Integrity, Patient Access, and Compliance teams
- Monitor CMS and payer compliance (IMM/MOON, authorizations, documentation standards)
- Drive patient flow initiatives to support timely admissions, transitions of care, and discharge planning
- Analyze data, trends, and outcomes to support quality improvement and financial stewardship
- Participate in hospital and system‑wide committees and strategic initiatives
- Support effective use of EPIC (TogetherCare) and reporting tools
Benefits
- Equal Opportunity Employer
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What This Job Offers
Job Type
Full-time
Career Level
Manager
